Treatment of Gambiense HAT in Children Under 6 Years or Body Weight Under 20 kg with CSF Involvement
This protocol covers gambiense human African trypanosomiasis (HAT) in a specific paediatric sub-population — patients aged under 6 years or with a body weight under 20 kg — who present with neurological-stage disease.
Clinical scenario
Gambiense HAT in patients aged < 6 years or body weight < 20 kg, with a CSF white blood cell count > 5/µL or trypanosomes detected in cerebrospinal fluid. This age and weight profile, combined with CNS-stage markers, defines a distinct treatment sub-group with specific first-line recommendations.
First-line treatment approach
For this age and weight group with confirmed CNS involvement, the recommended first-line approach is a combination regimen (NECT) using two agents delivered by different routes over a defined schedule. A single-agent alternative is recognised as the second choice specifically for patients meeting these age and weight criteria.
Full agent selection, routing, scheduling, and duration are detailed in the complete protocol below.
References
It is also the first choice of treatment for patients aged < 6 years or body weight < 20 kg presenting with > 5 WBC/µL or trypanosomes in CSF.
NECT consists of oral nifurtimox and intravenous eflornithine (α-difluoromethylornithine or DFMO): nifurtimox 15 mg/kg per day orally in three doses for 10 days; eflornithine 400 mg/kg per day intravenously in two 2-hour infusions (each dose diluted in 250 mL of water for injection) for 7 days.
The second choice to NECT is eflornithine monotherapy if aged < 6 years or body weight < 20 kg; or fexinidazole above those thresholds.
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